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Low Back Pain

How common is low back pain?

Low back pain is a very common complaint in many clinics in Hong Kong (HK), with between 60 and 80% of the general population being affected at some stage of their lives. Although most individuals recover within 6 weeks, 5 to 15% are unresponsive to treatment and have continued disability, severely affecting their quality of life.

What are the causes of low back pain?

The majority of low back pain is mechanical in nature. Clinically, the exact cause of any low back pain is often difficult to determine due to the vast number of structures in the low back that could be the source of pain. Sometimes radiographic or other studies are required to determine the diagnosis. The most common conditions seen by a chiropractor in Hong Kong are:

Other causes of low back pain may include referred pain from internal organs, such as the kidneys. Because of the various causes of low back pain, both mechanical and non-mechanical, it is important to obtain a correct diagnosis before proceeding with treatment.

What signs of low back pain require immediate attention?

If you develop the following signs and symptoms, you should see your doctor immediately. It could indicate a serious condition that may need immediate medical attention:

  • Back pain persisting beyond a few days
  • Back pain that awakens you at night
  • Difficulty controlling bowel or bladder function
  • Back pain that is accompanied by fever, chills, sweats or other unusual symptoms

What is the chiropractic treatment approach for low back pain?

  1. Reduce Pain - For both acute and chronic pain, the goal of treatment initially would be to reduce the pain, or to “break the pain cycle”. As the pain level is reduced, the muscles will relax, reversing the pain cycle. Certain modalities may be employed to provide pain relief and reduce inflammation at this stage, such as interferential current therapy, ultrasound therapy, dry-needling, ice/heat cycle, etc.
  2. Restore normal joint mechanics - Depending on the examination findings, your chiropractor will adjust (manipulate) the vertebral joints that are misaligned (subluxated). A chiropractic spinal adjustment is a high-velocity, low-amplitude force directed to specific joint segment(s). Sometimes other techniques are also employed to effect the correction, including flexion-distraction, drop table, etc.
  3. Improve flexibility and strength – To prevent future injuries, it is important to improve the flexibility of the joints and the strength of the core muscles. Your chiropractor will advise you on appropriate stretching and strengthening exercises according to your physical needs and fitness level.
  4. Lifestyle adjustments – Exercises, diet, working posture, sleep etc. play a vital role in the development and otherwise prevention of low back pain. Your specialist in chiropractic will work with you to identify lifestyle adjustments that will help you maximize the quality of your health.

How effective is chiropractic treatment for low back pain?

Over the past few decades, numerous independent researchers and government agencies have conducted studies that focus on the efficacy, appropriateness and cost-effectiveness of chiropractic treatment. Several of these important studies are listed below:

Manga Report - "Chiropractic manipulation is safer and more cost-effective than medical management of low back pain (LBP). There is good empirical evidence that patients are very satisfied with chiropractic management of LBP."

From Manga P. et al. "The Effectiveness and Cost-effectiveness of Chiropractic Management of Low Back Pain"; funded by the Ontario Ministry of Health; Canada. Kenilworth Publishing, Richmond Hill, Ontario; 1993.

RAND Studies - “Chiropractors deliver a substantial amount of health care to the US population; Spinal manipulations are of benefit to some patients with low back pain.”

From the RAND study (1993), a four-year study conducted in early 1990’s by one of US’ most prestigious centre for research in public policy, science and technology. The study was conducted by an expert panel of researchers including medical doctors and chiropractors.

U.S. Government Agency Report - "The panel found manipulation to be a recommendable method of symptom control. Relief of discomfort (low back pain) can be accomplished most safely with spinal manipulation, and/or nonprescription medication."

From "Acute Low Back Problems in Adults. Clinical Practice Guidelines No. 14." Bigos S. Bowyer D. Braen G. et al. AHCPR Publication No. 95-0642, Rockville MD.; Agency for health Care Policy and Research. Public Health Services, U.S. Department of Health and Human Services; December 1994.

Meade Study (1990) - “For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.”

From Meade TW, et al. “Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient.” British Medical Journal. 1990, 2 June

Meade Study (1995) - “When chiropractic or hospital therapists treat patients with low back pain…those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.”

From Meade TW, et al. “Randomized comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.” British Medical Journal. 1995, 5 August.

New Zealand Commission Report

“1. Spinal manual therapy in the hands of chiropractors is safe.

2. Spinal manual therapy can be effective in relieving musculo-skeletal symptoms such as back pain, and other symptoms, such as migraine.

3. Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy.

4. In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners.”

From NZ Commission of Inquiry, a study conducted in 1978-80. Above conclusion was based on investigations in New Zealand, the U.S., Canada, the United Kingdom, and Australia.

Gallup Poll – “90% of chiropractic patients felt their treatment was effective; more than 80% were satisfied with that treatment; and nearly 75% felt most of their expectations had been met during their chiropractic visits.”

From a demographic poll conducted by the Gallup Organization (1991)

British Clinical Guidelines - "Consider manipulation treatment within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities. The risk of manipulation is very low in skilled hands."

From "Clinical Guidelines for the Management of Acute Low Back Pain." Royal College of General Practitioners; Chartered Society of Physiotherapy; Osteopathic Association of Great Britain; British Chiropractic Association; National Back Pain Association; September 1996

Back Pain Prevalence in Hong Kong

While back pain is common around the world, research by specialists has found an estimated 57.1% of the Hong Kong population has experienced lower back pain at least once in their lifetime. Across the 3 million people comprising the working population in HK, approximately 900,000 days of sick leave were granted for back pain and HK$513 million were paid for clinical consultations because of work-related low back pain.

Compared to other nations such as Great Britain, back pain sufferers in Hong Kong are less likely to seek professional clinical treatment for their symptoms. This can be attributed to various factors, however it is always advisable to ensure treatment is pursued if your back pain is affecting your life.

What are some of the Recommended Treatments for Mechanical Low Back Pain?*

Author: Dr Claudia Ng, BSc, DC

Effective relief from low back pain starts from a proper examination and diagnosis. In Hong Kong, chiropractors are licensed primary healthcare practitioners who can help identify the causes of your back pain and formulate a treatment plan suitable to your needs. Please don’t hesitate to ask any questions and you’ll receive professional advice based on the most up-to-date scientific evidence.

* A proper diagnosis has to be obtained for all of the above conditions before an appropriate combination of treatments will be provided. This is just a list of possible treatments for the individual condition but not all of them may be necessary, nor is it limited to those listed only.

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